| NPI | 1598593931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 372600000X Adult Companion |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 172V00000X Community Health Worker | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2024-07-25 |
| Last Update Date | 2025-05-23 |